Abstract
Background Numerous programs have arisen to address interruptive clinical decision support (CDS)
with the goals of reducing alert burden and alert fatigue. These programs often have
standing committees with broad stakeholder representation, significant governance
efforts, and substantial analyst hours to achieve reductions in alert burden which
can be difficult for hospital systems to replicate.
Objective This study aimed to reduce nursing alert burden with a primary nurse informaticist
and small support team through a quality-improvement approach focusing on high-volume
alerts.
Methods Target alerts were identified from the period of January 2022 to April 2022 and four
of the highest firing alerts were chosen initially, which accounted for 43% of all
interruptive nursing alerts and an estimated 86 hours per month of time across all
nurses occupied resolving these alerts per month. Work was done concurrently for each
alert with design changes based on the Five Rights of CDS and following a quality-improvement
framework. Priority for work was based on operational engagement for design review
and approval. Once initial design changes were approved, alerts were taken for in
situ usability testing and additional changes were made as needed. Final designs were
presented to stakeholders for approval prior to implementation.
Results The total number of interruptive nursing alert firings decreased by 58% from preintervention
period (1 January 2022–30 June 2022) to postintervention period (July 1, 2022–December
31, 2022). Action taken on alerts increased from 8.1 to 17.3%. The estimated time
spent resolving interruptive alerts summed across all nurses in the system decreased
from 197 hours/month to 114 hours/month.
Conclusion While CDS may improve use of evidence-based practices, implementation without a clear
framework for evaluation and monitoring often results in alert burden and fatigue
without clear benefits. An alert burden reduction effort spearheaded by a single empowered
nurse informaticist efficiently reduced nursing alert burden substantially.
Keywords
clinical decision support - nursing alert burden - alert fatigue - quality improvement
- nursing informaticist
